Monday, July 20, 2009

Dropped Metatarsals

Did a long run this weekend in my Vibram FF's. I've been doing these mainly at Pineland of late but didn't have the time to drive up there so just went locally, which means I ran about 1/3 of it on asphalt. The harder surface caused a tender spot on the bottom of my foot I'd been neglecting the past week to get a little worse. This isn't something I'd felt much running in shoes but the lack of cushion made it worse. I was able to stop and snap a few things loose in my foot, which made the pain go away for the most part, but if I weren't a sports chiropractor with an affection for feet, this probably would have cut my run short and had me looking for new shoes.

The pain I felt was from a Dropped Metatarsal. I can't remember if this is an official diagnosis but that's what I call it.

The metatarsal is the bone that connects the toe to the arch of the foot. The cuneiforms and the cuboid (of 'Born to Run' fame) are the row of bones comprising the arch where the metatarsals attach. The illustration below is provided by none other than Leonardo DaVinci, who, when he wasn't too busy painting the Mona Lisa or inventing flying machines, studied the human foot and called it, "A masterpiece of engineering and a work of art."

The individual bones of the foot are connected by joints. Just like any other joint, they are succeptible to becoming restricted, inflamed, and tender. The second and third cuneiforms, because they comprise the apex of the arch of the foot, are especially prone to becoming fixated. When this happens, pain can develop on the underside of the foot, often right in the middle where the cuneiform abuts the metatarsal. It is especially pronounced when going barefoot on hard surfaces (which I can attest to.) It can also affect the ball of the foot where the metatarsal attached to the toe, which often creates a pain similar to stepping on something sharp.

Typically a fixated metatarsal is stuck in a pushed down position, requiring me to literally push it back up to free up the joint. This is why I call it a "dropped" metatarsal.

The best remedy for this issue is to have the foot manipulated to restore motion to the affected joints. In simple cases the pain will often immediately improve. I recently treated a severe case of this that required 5-6 visits on my part to finally get the stuck joints released. However even in that case the pain improved immediately once we succeeded.

This is a condition that I find frequently accompanies other foot issues such as plantar fascitis or neuromas. It is not uncommon to have a runner who has been diagnosed with these other conditions, when in fact the most tender spot on their foot is the restricted cuneiform/ metatarsal. In some of these cases once we free up the joint issue the remaining plantar fascia or neuroma pain turns out to be less than what was thought, if at all. The severe case I mentioned above had been diagnosed with both of these conditions, and, having had no luck with conventional treatments was facing surgery.

Ultimately the key to preventing this from happening again is to better support the arch. This is done by either increasing the amount of arch support with shoes and/ or orthotics, or by strengthening the muscles that provide internal support. If you've seen me or read any of my other posts you can probably guess which approach I favor.

Tuesday, July 14, 2009

How to Quickly Raise Your VO2 Max

Here is a belated follow up to my entry (see First Post) regarding a radical intensity training plan:

So after following this plan for one month, the biathlete I described raised his VO2 max by 10 points! (Not 10% but 10 points, as measured in a lab.) He described the plan for me for anyone interested:

-Find max heart rate (you may already know it)
-Want to be working at 90-95% of max HR during intervals. It's easiest to achieve this consistently on the treadmill where you can account for all the variables except yourself. I have chosen 15% grade and starting speed of 6mph because this brings it closer to skiing. You may choose a lesser grade, but will likely have to compensate by increasing the speed. Once you accomplish the same protocol twice in a row, increase the speed 0.1mph. Repeat.
-Interval structure is 5 by 5 minutes at chosen speed and grade, with 2 minutes recovery in between. Recovery should be active, with reduced speed and grade (a brisk walk or slow jog).
-Do this workout M-W-F
-Workouts on T-Th-Sa take the form of a 30 minute sustained threshold interval. Basically aiming for 85% of max HR.
[Sun was a rest day. Repeat this for four weeks.]

One amazing thing about the results here are that this is an already highly conditioned athlete. You could take a couch potato and put them through a training program and get stellar results, but it is much harder to make big gains in such a short periof of time in a fit person. He actually has two more cycles of these to go through heading into this ski season.

I plan on trying this using a treadmill this winter. Hard to incorporate it when right in the middle of training for a distance event, but I would love to get faster. I've been running some of the weekly Boulevard 5K's and then this past weekend did the Bradbury 6 mile trail race. Find that I am getting almost the exact same times as last year, which is a little frustrating. Plan on trying a mini "crash" week this week where you increase the intensity of training for 1-2 weeks (as described by Joe Frield in 'The Triathletes Training Bible.') Hopefully this will make me a little faster heading into Beach to Beacon.

OK enough about my middle of the pack struggles. I'll get back to injury prevention topics in subsequent posts.

Wednesday, July 8, 2009

Vermont 50K

So Linda and I have signed up for the Vermont 50K trail race in September. This will be the longest distance either of us has run on or off road. I had decided to focus on running this summer and skimp on the triathlon training. Then mother nature reinforced my plans by raining out the entire month of June and the biking and swimming have fallen by the wayside.

I was looking to do a trail marathon. Reading Born to Run and meeting some of the local ultra people around has inspired me to try my first ultra. I've done two road marathons in the past but just can't stomach the thought of running that far on the road theses days. There aren't many trail marathons around so I settled on the Vermont 50K. I'd honestly rather run an extra 4 miles on trail than 26 on the road.

Once I decided and ran it by the boss, she said, "Well you better get on the horn."
"You mean get on the ball, and start training?" I said (with typical spousal sarcasm.)
Thinking quickly on her feet, she came back with, "No jack***, get on the horn and start telling some people. That way you'll have to follow through."

So, thought I would put my goal on the blog. I'm sure training for this race will provide some good blog-fodder.

Linda had planned on doing the Maine marathon this year, but she's been enjoying her trail running so much this year she decided to join me in Vermont. We had to sit down one night with a calendar and literally spent an hour coming up with a schedule where we could both run four days week and maintain family homeostasis. Basically we decided that if we went to bed one hour earlier each night (essentially giving up one hour of TV) and got up earlier, it could work. After following the schedule for one week to make sure it worked we signed up for the race.

I'm resisting the urge to attach any time expectation to the race. My goal is to find a pair of trail shoes that allow me to maintain my barefoot/Vibram form on a rocky 50K trail, and to just enjoy the experience.

Sunday, July 5, 2009


OK so the great Pineland barefoot experiment lasted all of 4 minutes. Two minutes to realize that the trails there weren't quite as soft as I remembered, then two more to get back to the car to retrieve the Vibrams. Somehow I was remembering lush grass paths, which there are a few of, but it doesn't take much gravel to ruin the experience. I was more concerned with being able to open up my stride and get in a good long run than tip-toeing over rocks.

I did finish off the run with a half hour of barefoot running around the grass of the campus proper, which I've done in the past. I will say that the Pineland campus is a great place to get in some barefoot running. The fields at Twin Brook in Cumberland are another good place to get in a little distance sans shoes.

I actually spent most of the rest of the day barefoot, taking the kids to the beach and then some backyard wiffleball. By the end of the day my feet felt swollen and sore. Linda took a picture:

Just kidding- this is a picture I found online taken of a tribal villager who had never worn shoes a day in his life. I can't imagine this guy ever suffered from bunions or heel spurs!

A quick reiteration here: I'm not advocating that runners throw away their shoes. But barefoot running, as a form of training, promotes good form and strengthens your feet and legs. It's a great way to help prevent injury or as part of rehabing from an existing injury.

Saturday, July 4, 2009

Barefoot Running Part 2

I received an email from a holistically minded friend recently with a link to some information about the concept of grounding. It is known that as we live and breathe, and particularly exercise for long periods, we build up a net positive charge and free radicals, which are atoms in need of an electron. This is known to be bad for your health, and the reason anti-oxidants are talked about so much these days. The surface of the earth has a net negative charge, meaning a surplus of electrons. Therefore the theory of grounding holds that if you are in skin contact with the earth, particularly outdoors in the grass, dirt, rock, etc. you ground yourself and tap into the earth's unlimited supply of electrons to dissipate your positive charge and free radicals. (I apologize if the details aren't quite right but it's been many years since I took physics.) I had heard of this before, that Lance Armstrong's former chiropractor on US Postal recommended athletes lay out in the grass after a hard workout to ground themselves. For anyone who has seen me sprawled out in the grass after a race, fatigue, nausea, and pain were only half the reason!

The theory continues that one consequence of being inside most of the time and then wearing rubber soled shoes when you do go outside diminishes your ability to be grounded and is harmful to your health. I was describing this to a scientifically inclinced friend who made a comment about crossing over from physics into metaphysics. However even if grounding isn't true, I don't mind passing along advice if the end result is that people reading this would feel inclinced to go outside and take their shoes off!

I will be doing more reading up on this topic myself. As with many health topics, it seems intuitive to return to something that our ancestors spent a lot of time doing.

In any case after hearing of grounding I was inspired to do my next morning's speed workout barefoot in the grass at some ball fields, something I had done in the past but not so much recently since getting (rubber-soled) Vibrams. I don't know if it was the grounding effect but the workout felt much better than I was anticipating. So good that on my next run, as I was going through Evergreen cemetary, I decided to kick off the shoes again and tromp around the grass there for the next 45 minutes or so. Again, the run felt awesome. However, being in the cemetary there was a lot more paved, dirt, and gravel road crossings to contend with and by the end my feet felt pretty raw. I put my shoes back on (light-weight trainers) to run the paved road home, and suddenly had an epiphany, bringing me to the original inspiration for this post...

... after running barefoot for 45 minutes over all sorts of surfaces, I realized that the only reason I needed shoes was to protect the skin of my feet. I didn't need them for cushioning. I didn't need them for stability. I didn't need them for pronation control. My feet, conditioned through many months of Vibrams running, did just fine on their own. I basically just needed a little protection from the elements. These particular shoes were light enough to allow me to continue the high cadence, mid-foot striking groove I had gotten into running barefoot moments ago. But had they been any heavier I know they would have interfered rather than helped my form.

I have read, written, and explained to others this concept, but that morning I really FELT it.

I'm due for a long run at Pineland this morning, and plan on staying in contact with Mother Earth for as long as my little feet will hold out.

Happy 4th!